Professional Practice Assignment: Ethical Dilemma Case Study Analysis

This case study analyzes an ethical dilemma faced by a nurse in a hospital setting. The scenario involves a 45-year-old patient, Jim, admitted with severe chest pain and an advanced directive prohibiting CPR and other medical interventions. When Jim becomes unconscious, his wife demands that the nurse perform CPR, creating a conflict between the patient's wishes and the wife's demands. The nurse, bound by the advanced directive and professional standards, navigates this challenging situation. The analysis explores the ethical implications, the nurse's adherence to professional standards of practice, and the potential outcomes of the situation. It also discusses the nurse's actions in consulting with senior staff and waiting for the doctor. The case study highlights the importance of respecting patient autonomy, managing family expectations, and upholding ethical principles in nursing practice, with references to relevant legislation and professional standards. The analysis provides insights into the complexities of end-of-life care and the ethical considerations that nurses must address.

RUNNING HEAD: ETHICAL DILEMMA 1
Advanced Directives Ethical Dilemma
Student Details:

ETHICAL DILEMMA 2
For this essay, I have selected Case study 1 (Advanced Directives Ethical Dilemma)
which focuses on the study of Jim, 45 year old male admitted in the hospital with severe chest
pain. Jim’s legal document states the prohibited use of CPR and other medical treatment
procedures. Further, when Jim gets unconscious, Jim’s wife yells at the nurse and asks the nurse
to save Jim. Therefore, nurse tries to calm the situation and makes the wife understand that they
cannot do anything in this situation.
In this situation, the ethical dilemmas related with care of patients have influenced and it
is essential to know the legislations, which affects the nursing practice. As per this case study of
Jim the situation is an ethical dilemma as per laws and legislations nurse cannot perform any
medical procedure on Jim and his wife forced the nurse to perform CPR on Jim. The nurse
already ordered X-Ray and blood test to check what is going on. However, the nurse was waiting
for the doctor and the wife gave dirty looks to the nurse, which shows this is an ethical dilemma.
The nurse followed all the correct procedures as per the advanced directive. After remembering
the legislations carried by Jim’s wife, the nurse was unable to do the CPR and other medical
procedures. Furthermore, after an hour, Jim’s condition got worst and he was in unconscious
state. Additionally, the nurse tried to calm the situation as Jim’s wife was yelling at nurse but the
wife was not ready to listen to the nurse and she started CPR on Jim (DC Abrams, 2014). As per
the situation, the nurse followed appropriate method. The following condition was contradictory
for the nurse because on one hand where she was bounded by the legislations and rules carried
by the directives on the other hand there was the patient who was unconscious and probably
dying. If nurses know, about the health care directives, it becomes essential for them to fulfil the
wish of patient and herein Jim’s wish was not to perform any medical procedure. The following
situation is of severe chest pain faced by patient named Jim whose condition is getting worse and
unconscious. His wife forced the nurse to perform medical treatment meanwhile the nurse denied
to perform as it was against the advanced directive principles. The wife even yelled at the nurse
but the nurse was following the advanced directive. Hence, the nurse was fulfilling the patient’s
wish of not getting any treatment (KM Swetz, 2011). According to the situation faced by nurse,
it can be suggested that the nurse can move to the senior/head nurse in order to find an ethical
solution to problem, which can further provide guidance in regards to institutional policies for
such situations. Meanwhile the nurse can also wait for the doctor to come and intervene in the
situation and acknowledge the wife about the advanced directive principle and medical

ETHICAL DILEMMA 3
procedure. It is essential for the nurse and other medical staff to calm Jim’s wife and help her in
understanding that it is the wish of Jim of not getting any medical treatment (TH Tajouri, 2012).
After analysing the following situation, it is observed that because of the boundation
proclaimed by advanced directive principles the nurse cannot disregard the wish of patient of not
conducting any medical treatment over him. Two most precise outcomes, which can be drawn
out of the situation, are firstly, the condition of Jim may get more severe, which can lead to death
or state of deep and prolonged unconsciousness. Secondly, because of the degrading conditions
of Jim his wife can eventually blame the medical staff of not providing any medical treatment to
him (C Chen-Scarabelli, 2015). Consecutively, the attending nurse can notify the senior nurse
about the situation, so that the nurse can get the directions to handle such situations or the nurse
can wait for the doctor as well. Additionally, the nurse can make the wife to understand the
situation and let the hospital fulfil the wish of patient. Furthermore, the outcome of this situation
is that the wife will be annoyed and will blame the hospital staff for the worse condition of Jim.
As per the situational study of Jim in Part 1, this section comprises of four professional
standards of practice based on CLPNBC which reflects the ethics of nursing, clarify the
expectations for LPN practice in BC (BCCNP, British Columbia College of Nursing
Professionals, 2018). Therefore, the first standard is responsibility and accountability. As per the
legislations, the nurse maintains the current registration. Therefore, as per the case study of Jim,
the nurse followed the correct procedure and remembered the advanced directive on time and
stopped the treatment. Furthermore, the nurse learns to maintain competence to practice wherein
as per the study of Jim the nurse actually followed the rules of advanced directive. Additionally,
the nurse controlled the emotions in order to fulfil the wish of patient. The nurse was fit for the
situation as the nurse practiced within own level of competence, policies and all relevant laws
associated with Jim’s situation. By doing this, the nurse was professional and took the right
decision as per the advanced directive. Additionally, the nurse waited for the doctor for guidance
and direction in this regards. The nurse understood the role of CLPNBC during nursing practice
(S Melrose, 2012).
Furthermore, Competency-based practice reflects the accessing of information to provide
and support safe ethical nursing care and practice for clients. Therefore, the nurse first tried to
help the patient as she ordered the X-ray and blood tests and when the nurse remembered the

ETHICAL DILEMMA 4
advance directive, suddenly stopped the CPR though the patient’s condition was getting worse.
Additionally, as per the standard, the nurse correctly identified and took relevant decision about
client advanced directive and requirements of care. After being forced by the wife, the nurse
abides by the standards which reflect responding and adapting to changes in the environment of
practice (BCCNP, Professional Standards, 2019). As per client-focused provision of services, the
nurse correctly focused on focused on providing nursing care, but when the nurse learned about
the needs as per advanced directive of Jim, the nurse stopped providing medical treatment to Jim.
The nurse waited for the doctor to come and tried to calm the wife. Furthermore, the nurse
recognized the standard of advanced directive and did not follow any unethical practice. The
nurse tried to coordinate and facilitate of continuity of care services for the client, however, the
nurse when remembered the advanced directive, the nurse stopped the treatment right away.
Ethical practice standard basically focuses on honesty and integrity, self-clear representation,
client worthy, dignity and diversity. Therefore, as per Jim’s case study, the nurse followed
professionalism and tried to calm his wife as the clinical situation of Jim was getting worse. The
nurse abides by the standards and stopped providing treatment to Jim because of the advanced
directive.

ETHICAL DILEMMA 5
Bibliography
BCCNP. (2018, 09 04). British Columbia College of Nursing Professionals. Retrieved from
BCCNP.ca:
https://www.bccnp.ca/Standards/LPN/StandardResources/LPN_ProfessionalStandards.pd
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BCCNP. (2019). Professional Standards. Retrieved from BBCNP.ca:
https://www.bccnp.ca/Standards/LPN/ProfessionalStandards/Pages/Default.aspx
C Chen-Scarabelli, L. S. (2015). Dilemmas in end-stage heart failure. Journal of geriatric
cardiology, 12(1), 57.
DC Abrams, K. P. (2014). Ethical dilemmas encountered with the use of extracorporeal
membrane oxygenation in adults. Chest, 145(4), 876-882.
KM Swetz, P. M. (2011). The use of advance directives among patients with left ventricular
assist devices. Hospital Practice, 39(1), 78-84.
S Melrose, J. M. (2012). Becoming socialized into a new professional role: LPN to BN student
nurses' experiences with legitimation. Nursing research and practice, 2012.
TH Tajouri, A. O. (2012). The use of advance directives among patients with implantable
cardioverter defibrillators. Pacing and Clinical Electrophysiology, 35(5), 567-573.